Integrated Primary Care Behavioral Health Competency Training … · 2018-10-24 · Annual...
Transcript of Integrated Primary Care Behavioral Health Competency Training … · 2018-10-24 · Annual...
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Integrated Primary Care Behavioral Health Competency Training in Two Large Medical Systems: Practical Lessons Learned• Lisa K. Kearney, Ph.D., ABPP, Associate Director for Education, VA Center for Integrated Healthcare• Gregory Beehler, Ph.D., Associate Director for Research, VA Center for Integrated Healthcare• Anne C. Dobmeyer, Ph.D., ABPP, Psychological Health Center of Excellence, Defense Health
Agency• Katherine Dollar, Ph.D., Associate Director for Implementation, VA Center for Integrated
Healthcare• Joseph Grasso, Ph.D., Education and Implementation Specialist, VA Center for Integrated
Healthcare• David Hunsinger, MD, MSHA, Medical Director, Binghamton VA Outpatient Clinic• Christopher Hunter, Ph.D., ABPP, DoD Program Manager for Behavioral Health in Primary Care• Andrew Pomerantz, M.D., National Director for Integrated Care, VA Central Office• Katharine Van Treese, LCSW, Supervisor, VISN 2 Behavioral Telehealth Center• Laura O. Wray, Ph.D., Executive Director, VA Center for Integrated Healthcare
Session # G6
CFHA 20th Annual ConferenceOctober 18-20, 2018 • Rochester, New York
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Faculty Disclosure
The presenters of this session have NOT had any relevant financial relationships during the past 12 months.
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Conference Resources
Slides and handouts shared in advance by our Conference Presenters are available on the CFHA website at http://www.cfha.net/?page=Resources_2018
Slides and handouts are also available on the mobile app.
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Learning ObjectivesAt the conclusion of this session, the participant will be able to:
• Discuss options for training their integrated primary care behavioral health (PCBH) workforce in the unique competencies required for primary care
• Identify common challenges in implementation of a systematic integrated PCBH training program and methods for overcoming these challenges
• Create an initial plan for local development of an integrated PCBH competency-based training program at their location
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1. Hoge M.A., Morris J.A., Laraia M., Pomerantz A., & Farley, T. (2014). Core Competencies for Integrated Behavioral Health and Primary Care. Washington, DC: SAMHSA - HRSA Center for Integrated Health Solutions.
2. Hunter, C. L., Goodie, J. L., Dobmeyer A. C., & Dorrance, K. A. (2014). Tipping points in the Department of Defense’s experience with psychologists in primary care. American Psychologist, 69(4), 388-398.
3. McDaniel, S. H., Grus, C., Cubic, B., Hunter, C., Kearney, L. K.,. Schuman, C., … Johnson, S., B. (2014). Competencies for psychology practice in primary care. American Psychologist, 69 (4), 409-429
4. Milller, B.F., Gilchrist, E. C., Ross, K. M., Wong, S. L., Blount, A., & Peek, C. J. (2016) Core Competencies for Behavioral Health Providers Working in Primary Care. Prepared from the Colorado Consensus Conference.
5. Pomerantz, A. S., Kearney, L. K., Wray, L. O., Post, E. P., & McCarthy, J. F. (2014). Mental health services in the medical home in the Veterans Health Administration: Factors for successful integration. Psychological Services, 11 (3), 243-253.
Bibliography / Reference
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Learning Assessment
A learning assessment is required for CE credit.
A question and answer period will be conducted at the end of this presentation.
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“Medically Ready Force…Ready Medical Force”
Primary Care Behavioral Health Training and Outcomes in the Department of Defense
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“Medically Ready Force…Ready Medical Force”
Acknowledgements
We would like to acknowledge the contributions of Justin Curry, Ph.D., and Melissa Kincaid, Ph.D., at the Psychological Health Center of Excellence, Defense Health Agency, for their contributions to DoD PCBH program monitoring and evaluation.
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“Medically Ready Force…Ready Medical Force”
Internal Behavioral Health Consultants (IBHC): Who are They?
• Licensed social workers and psychologists (n=214)• Work in Army, Navy, and Air Force clinics around the world• Placed primarily in family health and internal medicine clinics• Hired locally (no central oversight)• Most with no prior integrated care experience
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“Medically Ready Force…Ready Medical Force”
Training Program Overview
• Competency-based training approach• Designed to help IBHCs and clinics develop and demonstrate specific
primary care behavioral health (PCBH) competencies• Competencies assessed at two points in training cycle using the DoD Core
Competency Tool (CCT)1
1Adapted from the Air Force BHC Core Competency Tool (United States Air Force, 2002, Primary behavioral health care services practice manual. San Antonio, TX), with consultation from Mountain View Consulting Group.
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“Medically Ready Force…Ready Medical Force”
CCT v3.0
• 59 items comprising six dimensions− Clinical practice− Practice management− Consultation− Documentation− Administration− Team performance
• A subset of items must be demonstrated to remain in position
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“Medically Ready Force…Ready Medical Force”
Sample CCT Items
• Conducts efficient warm handoffs
• Interventions are collaboratively developed with the patient
• Appointments are routinely kept to 30 minutes or less
• Keeps on schedule with consecutive appointments
• Appointments are spaced in a manner consistent with a population health model as well as individual patient needs
• Regularly engages in behaviors to increase IBHC utilization
• Clarifies/reinforces other aspects of the primary care treatment plan
• Provides same-day verbal feedback to PCCs for every appointment
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“Medically Ready Force…Ready Medical Force”
Phases of Training
• Orientation
• Phase I (includes CCT evaluation)
• Phone mentoring
• Phase II site visit (includes CCT evaluation)
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“Medically Ready Force…Ready Medical Force”
Orientation
• Three week distance learning; self-guided learning activities
• Learning activities:
− Live webinars
− Readings
− Online training (military cultural competency)
− Reviewing PCBH video demonstrations
− Shadowing primary care clinicians (PCCs)
− Meeting with key clinic personnel
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“Medically Ready Force…Ready Medical Force”
Phase I
• Five day centralized training at a DoD Simulation Center
• Learning activities:
− Didactics: PCBH model, conducting PCBH visits, working with patients at risk for suicide, depression assessment/intervention, ethics
− Hands-on training in electronic health record (EHR) IBHC template
− Two days of role play with patient actors; CCT feedback from trainer
• IBHCs must pass select CCT items to begin seeing patients
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“Medically Ready Force…Ready Medical Force”
Phone Mentoring
• Six individual phone mentoring appointments with IBHC trainer
• Assistance with translating classroom learning into clinical practice
• Feedback on clinical documentation
• Tailored recommendations for practice management
• Preparing for Phase II site visit
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“Medically Ready Force…Ready Medical Force”
Phase II Site Visit
• Two day site visit from trainer
• Occurs three to four months after Phase I training
• IBHC observed providing patient care and consultation
• Trainer meets with primary care staff, supervisors, leaders
• Trainer provides on-the-spot training and rates with CCT
• Provides recommendations for IBHC and clinic leaders
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“Medically Ready Force…Ready Medical Force”
Program Monitoring and Evaluation
• Wide range of key program metrics are assessed on a quarterly basis
• Data pulled centrally and compiled into quarterly monitoring reports by Performance and Analytics Branch, Psychological Health Center of Excellence
• Complementary dashboards visually highlight key monitoring metrics at the IBHC and clinic level
• Data presented here are from second quarter of FY20181
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1Psychological Health Center of Excellence (2018, June). Psychological Health Analytics Report: IBHC monitoring report for FY18Q02. Defense Health Agency: Falls Church, VA
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“Medically Ready Force…Ready Medical Force”
Program Snapshot, FY18Q2
Unique patients seen and number of encounters seen by full-time IBHCs during monitoring period
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Adult Pediatric TotalUnique Patients 34,210
(91.6%)3,132 (8.4%)
37,342
Encounters 55,461 (92.1%)
4,730(7.9%)
60,191
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“Medically Ready Force…Ready Medical Force”
IBHC Dashboard Example
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“Medically Ready Force…Ready Medical Force”
IBHC Dashboard Example, cont’d
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“Medically Ready Force…Ready Medical Force”
IBHC Dashboard Example, cont’d
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“Medically Ready Force…Ready Medical Force”
Program Fidelity, FY18Q2
• IBHC encounters per patient • Patients by condition • Encounters with feedback to PCC• Administration of Behavioral Health Meaure-20 (BHM-20)1
• CPT codes used (proxy for length and type of appointment)• IBHC utilization (mean encounters per day worked)
1 Kopta, S. M., & Lowery, J. L. (2002). Psychometric evaluation of the Behavioral Health Questionnaire-20: A brief instrument for assessing global mental health and the three phases of psychotherapy outcome. Psychotherapy Research, 12(4), 413–426.
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“Medically Ready Force…Ready Medical Force”
Program Fidelity, FY18Q2
Encounters per patient with an IBHC during monitoring period
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Encounters Patients Percent1 21,854 63.9%2 7,322 21.4%3 3,015 8.8%4 1,168 3.4%5 450 1.3%6 199 0.6%7 88 0.3%
8+ 114 0.3%
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“Medically Ready Force…Ready Medical Force”
Program Fidelity, FY18Q2
Patients treated by IBHCs for conditions of interest during monitoring period
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Condition Total PercentAnxiety 7,560 22.1%Adjustment 5,779 16.9%Sleep 4,271 12.5%Depression 2,660 7.8%Nicotine 849 2.5%Pain 790 2.3%Obesity 678 2.0%PTSD 574 1.7%Other conditions 9,448 27.6%
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“Medically Ready Force…Ready Medical Force”
Program Fidelity, FY18Q2
Encounters with PCC feedback and BHM-20 administration
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Number of Encounters
Percent of Encounters
PCC Feedback 41,213 82.2%1
BHM-20 Administered
34,620 75.1%2
1 Excludes phone encounters2 Excludes phone and group encounters
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“Medically Ready Force…Ready Medical Force”
Program Fidelity, FY18Q2
Current Procedural Terminology (CPT) codes used
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CPT Code Total Encounters
96127 Brief Behavioral Assessment 34,031 (35.7%)
96152 Health & Behavior Intervention, Individual 24,801 (26.0%)
96150 Health & Behavior Assessment, Individual 19,830 (20.8%)
96151 Health & Behavior Reassessment 4,259 (4.5%)
90832 Psychotherapy, 30 minutes 2,648 (2.8%)
98969 On-line Medical Evaluation 2,340 (2.5%)
96153 Health & Behavior Intervention, Group 1,888 (2.0%)
90834 Psychotherapy, 45 minutes 683 (0.7%)
Other Other 2,673 (2.8%)
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“Medically Ready Force…Ready Medical Force”
Program Fidelity, FY18Q2
Average utilization (mean IBHC encounters per day worked)
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Quarter Encounters PerDay
FY18Q2 5.45
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“Medically Ready Force…Ready Medical Force”
Program Fidelity, FY17Q2-FY18Q2
IBHC utilization over past five quarters
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4.47
5.06 5.135.37 5.45
1
2
3
4
5
6
FY17Q2 FY17Q3 FY17Q4 FY18Q1 FY18Q2
Mean IBHC Encounters Per Day Worked
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“Medically Ready Force…Ready Medical Force”
Patient Outcomes, FY18Q2
• BHM-20 is primary patient outcome measure for program monitoring– Global Mental Health (GMH) score
• Comprised of all 20 items• Assesses a range of symptoms, functioning, well-being• Reliable change threshold is + 0.72
– Life Functioning (LF) scale• Comprised of four items• Assesses functioning in work/school, intimate relationships social
relationships, life enjoyment (recreation/leisure activities)• Reliable change threshold is + 0.87
• Other measures are included based on presenting problem
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“Medically Ready Force…Ready Medical Force”
Patient Outcomes, FY18Q2
Acuity of patients (based on BHM-20 GMH score) with a first IBHC encounter in the monitoring period
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25%
17%
8%11%
39%
Normal Mild Moderate Severe No data
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“Medically Ready Force…Ready Medical Force”
Patient Outcomes, FY18Q2
Patients1 exhibiting reliable change2 in BHM-20 GMH and LF scales
1Includes only those patients with baseline scores outside the normal range2Outcome scores from the three months prior to the monitoring period also included in analyses
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BHM-20Scale
Mean Initial Score
Reliable Deterioration
No Change Reliable Improvement
GMH 2.26 127 (2.0%) 4,682 (74.6%) 1,470 (23.4%)
LF 1.72 195 (3.0%) 4,626 (70.3%) 1,763 (26.8%)
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“Medically Ready Force…Ready Medical Force”
Lessons Learned
• Identify and operationalize core competencies for your system; plan how you will measure them
• Establish minimum requirement for use of standardized measures with all patients− Essential for program monitoring− Aids IBHC in providing measurement-based care
• Build data-mining capability within EHR − Include desired fidelity and outcome metrics − Ensure workflow and structure of EHR allows for ease of documenting
key data
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“Medically Ready Force…Ready Medical Force”
Lessons Learned, cont’d
• If limited ability to hire BH providers experienced in integrated care, provide training to develop (and demonstrate) core competencies
• Regardless of experience level, provide some degree of initial training and skills verification, as well as process for ongoing performance monitoring
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“Medically Ready Force…Ready Medical Force”
Q & A
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Integrated Primary Care Competency Based Training in the
Department of Veterans Affairs
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VETERANS HEALTH ADMINISTRATION 37
With appreciation to our VHA PCMHI Competencies Training Development
Workgroup and Program Evaluation Partners
• Jessica Ackermann• Peggy Arnott• Joel Baskin• Greg Beehler• Peggy Bramlet• Katherine Dollar• Pat Dumas• Brad Felker• Wade Goldstein• Joe Grasso• David Hunsinger
• Karey Johnson• Elyse Kaplan• Lisa Kearney• Johanna Klaus• Andy Pomerantz• Elizabeth Scheu• Beret Skroch• Katharine Vantreese• Tanya Workman• Laura Wray• Erin Zerth
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VETERANS HEALTH ADMINISTRATION
Need for Specific Integrated Primary Care Training• Most mental health providers lack skills necessary to succeed in
Integrated Primary Care (IPC, Serrano et al., 2018).
• Hiring and placing mental health providers without IPC training in PC settings is insufficient.– Function as independent practitioners– Provide general or specialty mental health services
• IPC requires mental health providers to work differently.– fast-paced– team-based care settings
• Necessitates the development of new skills to promote successful collaboration and same-day access to services (Dollar et al., 2018).
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VETERANS HEALTH ADMINISTRATION
Need for Specific IPC Training• Most Primary Care providers are not familiar with IPC.
– Interaction skills must be learned– Mechanisms for educating PCPs on services and their benefits– IPC requires modification of work flows
• Large deficits existed with Primary Care Mental Health Integration (PCMHI) – Same day access to PCMHI was routinely only occurring 1/3 of the time– PCMHI reach was not at desired levels
• Surveys and site visits revealed significant variability in implementation across sites. – Standardization of training offers a common knowledge base for
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VETERANS HEALTH ADMINISTRATION
SAMHSA Competencies
I. Interpersonal Communication
II. Collaboration & Teamwork
III. Screening & Assessment
IV. Care Planning & Care
CoordinationV. Intervention
VI. Cultural Competence &
Adaptation
VII. Systems Oriented Practice
VIII. Practice Based Learning & Quality
Improvement IX. Informatics
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VETERANS HEALTH ADMINISTRATION
National Competency Training Program
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Phase I
Conducted virtuallyBaseline assessment of competency, review of written materials, and online trainings Must be completed to attend in-person Phase II training
Phase II2.5 day in-person training with on hands-on role playing and demonstration skillsAt conclusion of passing of competency assessment, participants receive certification in CCC and/or CM (trainers must complete both)
Phase IIIVirtual follow-up at 3/6 months with role play and survey assessmentOngoing fidelity reviewed through self-report measures and national data* Booster training provided until fidelity is obtained.
Note: CCC = Co-located Collaborative Care, CM = Care Management *Looks at fidelity across time at the provider and clinic levels (e.g., same day access, 30
minute appointments, penetration, return to clinic frequency, etc.)
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VETERANS HEALTH ADMINISTRATION
Decentralized Train the Trainer Model
Developers and SMEs
Step 1:
Regional Lead
Trainers (June 2017)
Step 2:
Facility Lead
Trainers(Sept. 2017)
Step 3:
All 1600+ Local
Clinicians
(Through Dec 2018)
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VETERANS HEALTH ADMINISTRATION
Program Evaluation: Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework
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Element Metrics Data Source
Reach Overall % of PCMHI staff who attend program, including demographics
% of those reaching initial certification% of those maintaining certification
Self-Report Surveys
Behavioral Demonstration
Effectiveness:(Including Fidelity)
Role play demonstrations Behavioral Demonstration
Adoption Penetration Rate (Facility Level) VA Administrative Databases
Implementation PPAQ-2 CCC & CM (Provider Level)Average Appointment Length (Provider & Facility Level)Average Return to Clinic Rate (Provider & Facility Level)
Self-Report SurveysVA Administrative Databases
Maintenance Items above at 3 AND 6 month follow-up Noted above
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VETERANS HEALTH ADMINISTRATION
Overview of Provider Participation• Massive, complex data collection process
– Survey data, admin data, demonstration data at baseline, 3, and 6 months– Staggered initiating of cohorts with individualized time frames for follow-up
• In first 6 months of rollout, 58 training cohorts initiated
• Target: 2,005 participants currently scheduled to be trained by Dec 31, 2018
• 1,207 participants trained to-date across 83 training cohorts• Based on educational background, training program participants
were largely similar to VA National PCMHI staff with 2 exceptions: – Psychologists were slightly over-represented in our program
• 44% v. 36% nationally– Physicians were slightly under represented in our program
• 10% v. 16% nationally 44
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VETERANS HEALTH ADMINISTRATION
Reach: Trainee Characteristics (Regional Trainer & Facility Leads)
Characteristic Regional Trainern = 19
Facility Leadn = 95
Current integrated care role n (%) n (%)PCBH-only 11 (57.9) 55 (57.9)Both PCBH and CM 6 (31.6) 39 (41.0)CM-only 2 (10.5) 1 (1.1)
Years in current integrated care role≤2 2 (10.5) 24 (25.3) 3-5 3 (15.8) 32 (33.6)>5 14 (73.7) 39 (41.0)
Educational BackgroundPsychologist (PhD/PsyD) 15 (78.9) 71 (74.7)MSW/LCSW (Masters-Level Provider) 2 (10.5) 15 (15.8)RN/APN 1 (5.3) 4 (4.2)Physician 1 (5.3) 2 (2.1)Other 0 3 (3.2) 45
Response rates: 73% Regional Trainers; 75% Facility Leads.
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VETERANS HEALTH ADMINISTRATION
Implementation - Regional Trainer Outcome Improvements in Co-Located Collaborative Care
46
Note: Repeated Measures ANOVA utilized for statistical analyses. Scores range from 1 to 5 (higher scores=higher fidelity) †Higher scores better (e.g., less prohibited behaviors utilized). Improvements (but non-significant) for clinical scopes and intervention, prohibited, and referral management and care continuity* Statistically significant.
4.25
4.3
4.35
4.4
4.45
4.5
4.55
4.6
4.65
Baseline 3 month 6 months
Practice and Session Management*
3.95
4
4.05
4.1
4.15
4.2
4.25
4.3
4.35
4.4
4.45
Baseline 3 month 6 months
Consultation, Collaboration, & Interprofessional Communication*
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VETERANS HEALTH ADMINISTRATION
Implementation Regional Trainer Outcome: Improvements in Care Management
47
Note: Repeated Measures ANOVA utilized for statistical analyses. Scores range from 1 to 5 (higher scores=higher fidelity) ). Improvements (but non-significant) for panel management.* Statistically significant.
4.3
4.35
4.4
4.45
4.5
4.55
4.6
4.65
Baseline 3 month 6 months
Pt. Education, Self Management Support,
Psychological Intervention*
3.1
3.2
3.3
3.4
3.5
3.6
3.7
Baseline 3 month 6 months
Supervision and Care Coordination*
3.7
3.8
3.9
4
4.1
4.2
4.3
4.4
4.5
Baseline 3 month 6months
Measurement Based Care and Protocol Adherence*
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VETERANS HEALTH ADMINISTRATION
Implementation Facility Trainer Outcome:Co-Located Collaborative Care
Note: Repeated Measures ANOVA utilized for statistical analyses. Scores range from 1 to 5 (higher scores=higher fidelity) †Higher scores better (e.g., less prohibited behaviors utilized)* Statistically significant.
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3.25
3.3
3.35
3.4
3.45
3.5
3.55
3.6
3.65
3.7
Baseline 3 month 6 months
Clinical Scope and Interventions*
4.1
4.15
4.2
4.25
4.3
4.35
4.4
4.45
4.5
Baseline 3 month 6 months
Practice and Session Management*
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VETERANS HEALTH ADMINISTRATION
Implementation Facility Trainer Outcome: Co-Located Collaborative Care
Note: Repeated Measures ANOVA utilized for statistical analyses. Scores range from 1 to 5 (higher scores=higher fidelity) †Higher scores better (e.g., less prohibited behaviors utilized)* Statistically significant.
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3.8
3.85
3.9
3.95
4
4.05
4.1
4.15
4.2
4.25
Baseline 3 month 6 months
Prohibited†*
4.1
4.15
4.2
4.25
4.3
4.35
4.4
4.45
Baseline 3 month 6 months
Referral Management and Care Continuity*
3.95
4
4.05
4.1
4.15
4.2
4.25
4.3
4.35
Baseline 3 month 6 months
Consultation, Collaboration, & Interprofessional Communication*
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VETERANS HEALTH ADMINISTRATION
Implementation Facility Trainer Outcome: Care Management
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Note: Repeated Measures ANOVA utilized for statistical analyses. Scores range from 1 to 5 (higher scores=higher fidelity) * Statistically significant.
4.15
4.2
4.25
4.3
4.35
4.4
Baseline 3 month 6 months
Patient Identification*
4.1
4.15
4.2
4.25
4.3
4.35
4.4
4.45
Baseline 3 month 6 months
Pt. Education, Self Management Support, Psychological Intervention*
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VETERANS HEALTH ADMINISTRATION
Implementation Facility Trainer Outcome: Care Management
51
Note: Repeated Measures ANOVA utilized for statistical analyses. Scores range from 1 to 5 (higher scores=higher fidelity). ). Improvements (but non-significant) for panel management* Statistically significant.
3.35
3.4
3.45
3.5
3.55
3.6
3.65
Baseline 3 month 6 months
Supervision and Care Coordination*
3.75
3.8
3.85
3.9
3.95
4
4.05
4.1
4.15
4.2
Baseline 3 month 6 months
Measurement Based care and Protocol Adherence*
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VETERANS HEALTH ADMINISTRATION
But what about actual change in provider observed behavior and clinic behavior?
This is all self report….
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PPAQ Self Report
Actual Clinic Administrative
Data
Standardized Case Role
Play
Regional Trainers Baseline: 92.3% Pass3-Month: 100% Pass6-Month: 100% Pass
Facility TrainersBaseline: 81.8% Pass3-Month: 93.4% Pass6-Month: 100% Pass
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VETERANS HEALTH ADMINISTRATION
Implementation Trainer Outcomes: Administrative Data
Note: Repeated Measures ANOVA utilized for statistical analyses. Scores range from 1 to 5 (higher scores=higher fidelity) * Statistically significant.
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40%
45%
50%
55%
60%
65%
70%
Baseline 3 month 6 months
Regional Trainer30 Minute Ratio*
40%
45%
50%
55%
60%
65%
70%
Baseline 3 month 6 months
Facility Trainer30 Minute Ratio*
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VETERANS HEALTH ADMINISTRATION
Overarching Outcomes for Regional/Facility Trainers• Self reported improvement on PPAQ –
even stronger with facility leads• Greater fidelity with actual clinic
behavior of 30 minute appointments– Implications for improvements in
same- day access• Particularly notable findings given this
sample included those already demonstrating higher fidelity IPC practices.
• Next steps: changes in frontline IPC provider behavior! (SNEAK PEEK!)
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VETERANS HEALTH ADMINISTRATION
Lessons Learned and Implications for Other Systems
55
• Process for trainer selection is critical.• Sustainable training models require significant oversight and
systems to support standardization (including data management systems)
• Prepare for trainer turnover.• Create mechanisms for continual feedback on the training itself, as
well as provider behavior and clinic changes.• Get leadership buy-in early. Report successes regularly. • Address interdisciplinary concerns with interprofessional
education. Create training for PC and MH teams together.
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VETERANS HEALTH ADMINISTRATION
Psychiatrists in Integrated Care
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• Collaborative Care Model- APA online training• Controversy in the field over role of psychiatry in PCMHI
– Does it discourage PCP taking responsibility?– Adds ability to treat more complex conditions
• But training challenges– “you’re trying to turn us into psychologists”– “I need much more time”
• Solutions:– Get the right people– 5As are S.O.A.P. with different letters
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VETERANS HEALTH ADMINISTRATION
Questions/Discussion
57
• What training tools might you wish to develop or apply in your own setting?
• What are actionable next steps you would like to take when you return to your clinic to improve fidelity of yourself or the team you oversee?
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VETERANS HEALTH ADMINISTRATION
Resources
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Fidelity Instrument• The Primary Care Behavioral Health Provider Adherence Questionnaire (PPAQ): Available
online - https://www.mirecc.va.gov/cih-visn2/PPAQ.aspTraining Tools for Core Elements• Primary Care Behavioral Health/Co-located Collaborative Care Functional Assessment
Training Tool (Based on 5As) - https://www.mirecc.va.gov/cih-visn2/Documents/Clinical/CCC_Functional_Assessment_Tool.pdf
• Primary Care Behavioral Health/Co-located Collaborative Care Follow-Up Appointment Training Tool (Based on 5As) - https://www.mirecc.va.gov/cih-visn2/Documents/Clinical/CCC_Follow_Up_Tool.pdf
• Collaborative Care Management/Care Management Initial and Follow-up Telephone Appointment Training Tools - https://www.mirecc.va.gov/cih-visn2/clinical_resources.asp
• Introductory Script for IPC Providers: https://www.mirecc.va.gov/cih-visn2/Documents/Clinical/BHP_Intro_Script.pdf
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VETERANS HEALTH ADMINISTRATION
Resources
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Rating Tools
• VA’s Core Competency Tool – contact us – [email protected]• DoD IBHC Core Competency Tool v3.0 -contact us -
[email protected]• Behavioral Health Consultant Outcome Rating Scale (Serrano et
al., 2017) - Serrano, N., Cos, T. A., Daub, S., & Levkovich, N. (2017). Using standardized patients as a means of training and evaluating behavioral health consultants in primary care. Families, Systems, & Health, 35(2), 174-183. doi:10.1037/fsh0000272
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VETERANS HEALTH ADMINISTRATION
Key Questions to Implement Trainingat Your Own Site
Step 1: Needs Assessment
• What are your training needs?
• Provider prior competency based training?
Step 2: Measures of
Success• Provider fidelity
measures (PPAQ?)• Clinic level outcomes
– Same Day access? Penetration rate?
• Competency Pass Rate?
• Tracking systems for program evaluation and data management
Step 3: Stakeholders
• PC/MH Leadership• Frontline staff• Support staff• Executive leadership
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VETERANS HEALTH ADMINISTRATION
Key Questions to Implement Training at Your Own Site
Step 4: Curriculum
Development
• Which model? CoCM? Behavioral Health?
• DoD? VA? Other?• APA Curriculum
available free• Consider prior
knowledge & expertise • Virtual training? In
person training? Combination?
• Regional train-the-trainer?
• Document storage and dissemination
Step 5: Pilot
• Identify initial “class”• Train trainers• Complete pre-
assessment• Complete prework• Gather 3 and 6 month
outcome data
Step 6: Implement
• How many sites?• Build Communities of
Practice• How to continue to
train trainers? • Re-evaluate and revise
curriculum
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Session Evaluation
Use the CFHA mobile app to complete the evaluation for this session.
Thank you!